Remuneration  of  Physicians 


JOHN  L.  IRWIN,  Ph.C.,  M.D. 
Detroit 


Reprinted  from 

The  Journal  of  the 
Michigan  State  Medical  Society 

Battle  Creek,  Mich. 


V. 


REMUNERATION  OF  PHYSICIANS 


JOHN  L.  IRWIN,  Ph.C.,  M.D. 
Detroit 


ONE  PHYSICIAN’S  METHOD  OF  INCREASING  HIS 
INCOME 


To  the  Editor: — I wish  to  contribute  a statement  to  the 
subject  of  the  remuneration  of  physicians: 

I have  been  in  the  general  practice  of  medicine  since  1890 
in  Detroit  on  the  same  lot  on  which  I was  born.  For  twenty 
years  I trusted  all  applicants  for  medical  aid  with  results 
approximately  as  follows: 

2 per  cent,  would  pay  ihe  promptly. 

13  per  cent,  could  pay  me  only  “when  I went  after  them.” 

25  per  cent,  got  out  of  paying  me  in  every  possible  way. 

60  per  cent,  did  not  pay  me  at- all. 

Jan.  1,  1910,  I turned  over  a new  leaf,  and  referred  to  other 
physicians  all  would-be  patients  who  did  not  pay  cash  and  had 
not  approved  credit.  In  1910,  the  income  from  my  practice 
was  98  per  cent,  greater  than  my  average  yearly  income  for 
the  preceding  twenty  years  and  my  expenses  for  1910  were 
less  than  the  average  yearly  expenses  for  the  same  period. 
Except  for  the  fact  that  I gave  my  individual  attention  to  my 
invalid  mother  for  the  three  years  prior  to  1908,  which  cut 
into  my  practice  considerably,  I am  unable  to  assign  any  other 
cause  than  this  change  of  policy  for  the  increase  in  income. 

Since  Jan.  1,  1910,  I have  had  more  time  for  reading, 
refreshment  and  sleep;  and  my  present  plan  is  preferable  to 
that  of  those  physicians  whose  ambition  is  to  have  the 
“largest*  practice”  in  a community  at  the  cost  of  poor  health 
or  an  early  death.  John  L.  Irwin,  M.D.,  Detroit. 


Reprinted  from  The  Journal  of  the  American  Medical  Association 
March  4 , 1911,  Vol.  LVI , p.  687 


Copyright,  1911 

American  Medical  Association , 535  Dearhom  Ave.,  Chicago 


HOURS. 


1.30  TO  3.30  P.  M. 

7.00  TO  8.00  P.  M. 

MORNINGS  AND  OTHER  HOURS  BY  APPOINTMENT 
SUNDAYS  AND  HOLIDAYS  2.30  P,  M ONLY 


Telephone  Main  3349 


230  THIRD  AVENUE 
DETROIT.  MICH. 


Professional  Fee  Bill  of  John  L.  Irwin,  M.  D. 

OFFICE  CONSULTATION,  EXAMINATION  OR  SPECIAL  OFFICE  SERVICE,  $1.00  ToVlO.OO  CASH. 

Ordinary  visits  $2.50  each  ; night  visits  $5.oo  each,  detention  extra  charge. 
Ordinary  office  service,  $1.50. 

Ordinary  confinement  (including  three  (3)  visits), 

Operations,  difficult  confinements,  electrical  tf 

IN  COURT,  UNUSUAL  MEDICINE  OR  OPTICAL  SUPPLIES,  SPECIAL  CHARGE. 

Office  consultation  to  strangers,  STRICT  LY  CASH. 

Accounts  due  whan  service  is  rendered. 

The  honest  indigents  free  of  charge. 


$25.00 

EATM 


ENTS, 


VISITS  IN  CONTAGIOUS  DISEASES,  ATTENDANCE 


Special  Notice  from  John  L.  Irwin,  M.  D. 

This  account  is  rendered  according  to  my  professional  fee  bill.  Items  may  be  seen  at  office. 

A DISCOUNT  OF IS  OFFERED  TO  

BUT  MADE  CONDITIONAL  TO  PROMPT  SETTLEMENT. 

IF  SATISFACTORY  ARRANGEMENT  IS  NOT  MADE  BEFORE FOR  SETTLEMENT, 

THE  DISCOUNT  IS  NOT  ALLOWED,  AND  DOES  NOT  APPLY  ON  ACCOUNTS  PLACED  FOR  COLLECTION  OR 
GARNISHMENT. 


Tt^t* 


REMUNERATION  OF  PHYSICIANS 


JOHN  L.  IRWIN,  Ph.C.,  M.D. 
Detroit 


The  twenty  years’  practice  mentioned 
in  my  article  on  this  subject  published  in 
The  Journal  of  the  American  Medical 
Association  1 was  confined  to  no  particular 
locality  in  Detroit,  patients  often  living 
in  extreme  limits  of  the  city,  and  repre- 
sented financially  all  classes.  Those  best 
able  to  pay  too  often  were  delinquents. 
There  should  be  some  practical  remedy 
for  the  financial  abuses  in  constant  expo- 
sure to  danger  and  % to  death,  of  the 
physician  — some  practical  way  should  be 
pointed  out  to  close  in  on  the  army  of 
deliberate  grafters  who  shorten  the  phy- 
sician’s life,  and  medical  men  should 
refuse  to  be  longer  “done”  by  them. 

Josh  Billings  advises  the  young  doctor 
to  ignore  the  disease  and  treat  the  patient. 
Do  not  our  “experienced”  and  “tactful” 
M.D.’s  who  keep  up  the  “bluff”  of  a large 
office  business  — doing  but  little  charging 
and  in  some  instances  causing  the  sick 
whom  they  visit  to  have  one  or  more  of  the 
neighbors  call  at  the  office  at  a partic- 
^.ular  time  to  daily  report  progress  — fol- 
«->  low  such  advice  ? In  this  and  in  other 
ways,  such  as  cases  from  their  free  clinics, 
do  they  supply  their  office  with  “stool 
pigeons,”  and  flim-flam  the  laity  into 
thinking  they  have  a large  office  business 
Lv  and  must  necessarily  be  “able”  physicians. 
* Ntt  is  told  of  one  of  our  physicians, 
here,  of  years  of  practice,  who  is  a 
j good  “mixer  and  joiner,”  that  he  regu- 
. r larly  gives  his  many  friends  “auto-rides” 
during  which  he  makes  fifty  or  more 
\ “stops,”  leaving  the  impression  of  having 
a “wonderful”  practice;  and  of'  another 
^ surgeon  who  tells  his  acquaintances  all 
^ about  his  many  and  “great”  operations. 

"ft 


fM 

i #> 


1.  March  4,  1911,  lvi,  687. 


Nor  is  the  average  busy  physician  either 
fair  to  himself  or  to  his  patient.  Instead 
of  scheming  to  keep  his  office  filled  at  any 
cost,  he  should  aim  to  limit  the  number 
of  his  cases;  and  thereby  give  those  w*ho 
do  consult  him  value  for  the  money  which 
they  pay  him,  and  at  the  same  time  guard 
his  own  hours  of  refreshment  and  sleep. 
As  physicians  we  know  too  well  that  the 
follies  of  youth  are  promissory  notes  which 
begin  to  fall  due  about  thirty  years  after 
date.  Just  as  true  is  it  that  an  over- 
worked 'physician  will  too  soon  lose  his 
health.  Of  the  prominent  Detroit  physi- 
cians in  active  practice  in  1900  more  than 
25  per  cent,  have  since  died.  Medical 
practitioners  are,  as  a class,  more  subject 
to  illness  than  are  their  fellow  men.  The 
combined  influence  of  anxieties  which 
weigh  on  them  in  the  amount  and  nature 
of  their  work,  irregularity  of  meals  and 
broken  sleep,  exposure  to  weather  and 
infection  — all  these  are  sufficient  to 
break  the  strongest  constitution ; hence 
they  should  insist  on  being  first  to  be 
paid  for  their  services  instead  of  last,  as 
is  too  often  the  case  at  present. 

Is  it  too  much  to  expect  that  the  day 
may  soon  come  when  the  very  tffbusy”  man 
whether  he  be  doctor  or  lawyer  will  be 
passed  by  for  the  good  reason  that  he 
undertakes  too  much  not  to  neglect  those 
wdio  have  a right  to  receive  value  from 
him?  It  is  but  natural  to  expect  to  be 
neglected  by  any  doctor  or  lawyer  whom 
one  employs  who  is  doing  too  much  work 
in  each  twenty-four  hours. 

That  the  “ethical”  physicians  of  repu- 
tation themselves  are  not  entirely  fair, 
take  for  example  the  matter  of  their  inter- 
views in  daily  papers  and  of  advertising. 


c 


4 


REMUNERATION — IRWIN 


We  say  that  to  buy  space  and  advertise  in 
a daily  paper  is  unethical,  and  yet  we 
allow  and  too  often  request  newspaper 
reporters  to  be  present  at  and  take  notes 
in  our  society  meetings,  annual  clinics  and 
conventions,  and  receive  a free  write-up 
in  all  the  local  newspapers  — then,  by 
mailing  broadcast  our  reprints  of  papers 
read  at  said  meetings  we  finish  the  "eth- 
ical graft.”  Are  we  not  less  consistent 
here  than  he  who  pays  his  money  to  the 
newspaper  for  space  and  whom  we  desig- 
nate as  a "quack”  ? Let  us  then  in  all  our 
work  call  a spade  a spade,  and  apply  the 
golden  rule.  There  will  then  be  fewer  and 
better  colleges,  fewer  and  better  physi- 
cians, and  best  of  all,  when  we  are  paid 
for  what  we  do,  a chance  to  make  an 
honest  living  from  what  at  present  is  an 
over- "done”  profession. 

In  every  large  city  there  are  already  city 
physicians,  free  dispensaries,  college  and 
hospital  clinics,  for  the  poor,  and  it  is  an 
economical  error  for  any  physician  to 
sacrifice  himself  in  building  up  an  unre- 
munerative  practice.  He  has  to  neglect 
his  own  health  and  to  forego  the  reading 
he  should  do  to  keep  himself  up-to-date; 
and  he  cannot  give  the  attention  to  any 
of  his  patients  that  they  deserve.  Colleges 
are  grinding  out  physicians  faster  than 
they  are  needed,  or  can  make  a living  for 
themselves,  as  it  is.  The  so-called  "busy” 
doctors  make  slaves  of  themselves  in  most 
cases  to  keep  up  the  "show”  and  are  worn 
out  too  early  in  life.  From  the  patients, 
even  those  who  are  able  to  pay  and  do  not, 
the  doctor  only  finally  receives  ingratitude. 
We  must  teach  our  patients  that  we  get 
our  living  by  our  calling  and  that  all 
must  pay  promptly  except  such  honest  in- 
digents as  we  ourselves  select  to  treat  free. 

We  who  believe  with  John  S.  Billings, 
M.D.,  that  medicine  is  not  a rigid  system 
of  rules  and  formulas,  as  it  was  in  ancient 
Egypt  — a fixed  creed  to  which  we  are  to 


subscribe  and  from  which  we  must  not 
vary;  but  a living,  growing  thing  making 
use  of  every  resource  which  the  progress  of 
science  brings,  testing  all  things  and  hold- 
ing fast  to  that  which  is  good  — we  who 
believe  this  should  not  hesitate  to  require 
the  just  compensation  for  our  labor  which 
will  be  a fair  return  for  our  large  finan- 
cial investment  in  years  of  college  train- 
ing, study  and  experience. 

Oliver  Wendell  Holmes,  M.D.,  said: 

“Could  Youth  but  know  what  Age  doth  crave 
Many’s  the  penny  Youth  would  save.” 

So  with  the  wise  physician : let  him  not 
by  the  poetry  or  imaginative  flight  of  the 
"extremist”  in  medical  ethics  strive  to  die 
for  the  physical  sins  of  the  people,  but 
rather  to  so  regulate  his  financial  affairs 
that  when  old  age  comes  on  him  he  will 
have,  then,  something  with  which  to  meet 
his  needs  more  substantial  than  the 
so-called  gratitude  of  the  people  whose 
physical  and  mental  distress  and  heart- 
ache he  relieved  without  money  or  price. 

I suggest  that  lists  of  "dead  beats”  or 
"deliberate  grafters”  and  "delinquents” 
be  filed  with  the  secretary  of  every  county 
medical  society  throughout  the  country; 
and  that  the  said  lists  be  revised  every 
three  months  — same  to  become  a book  of 
reference  for  use  of  members.  Let  us 
have  fewer  patients  and  better  fees;  those 
who  have  not  approved  credit  to  pay  cash 
at  each  house  visit  or'  office  consultation; 
statements  on  good  accounts  to  be  ren- 
dered monthly ; and  payment  required 
before  the  10th  of  the  month  following. 

The  American,  state  and  county  medi- 
cal societies  should  at  once  take  up  the 
subject  and  get  a practical  remedy,  giv- 
ing our  members  some  return  for  "annual 
dues”  beyond  scientific  papers  and  discus- 
sions for  the  "good  of  humanity,”  while 
too  many  of  our  members  who  depend 
wholly  on  their  practice  for  a living  are 
all  but  "starving  to  death.” 

230  Third  Avenue. 


A Sample  Health  Board  Propaganda. 


Detroit,  Mich.,  Feb.  28,  1903. 

To  the  Editor: — I accepted  the  appointment  as  a member 
of  the  Detroit  Board  of  Health  from  Governor  Pin- 
gree,  Feb.  21,  1899,  for  the  term  ending  Feb.  28,  1903. 

On  March  15,  1899,  certain  thoughts  of  mine  appeared  in 
the  Detroit  Evening  News  concerning  the  workings  of  the 
Detroit  Health  Department,  and  the  kind  of  man  needed  as 
health  officer.  These  thoughts  later  became  my  convictions, 
and  were  contained  in  my  fixed  policy,  and  were,  viz. : 

(a)  Health  officer  to  be  a clinical  physician  with  executive 
ability,  and  to  have  had  personal  experience  diagnosing  con- 
tagious diseases,  including  smallpox,  scarlet  fever  and  diph- 
theria. 

( b ) Health  officer  to  examine  personally  suspicious  or 
doubtful  cases  reported  to  the  department,  and  meet  person- 
ally private  physicians  asking  consultation  thereon. 

( c ) Health  office  to  be  operated  on  practical  business  prin- 
ciples, and  without  political  coloring. 

( d ) .Methods  of  health  office  to  be  up-to-date,  but  for 
every  dollar  of  cost  of  maintenance  the  department  to  obtain 
full  value  in  practical  results — all  unnecessary  expense  to  be 
eliminated. 

(e)  All  health  department  work  of  a medical  nature  to  be 
performed  by  the  salaried  physician  employes  of  the  city. 

(/)  Health  officer  and  all  employes  to  give  their  entire 
time  to  the  department.  Under  no  circumstances  should  per- 
sons on  regular  salary  be  paid  extra  compensation. 

Spencer  says : “Political  life  is  healthy  only  in  proportion 
as  it  is  conscientious.”  I have  endeavored  faithfully  to  en- 
force the  above  policy,  as  well  as  all  health  laws  and  ordin- 
ances applicable  to  Detroit,  with  what  success  the  official 
records  of  the  Detroit  Board  of  Health  will  show. 

John  L.  Irwin,  M.D. 


Reprinted  from  The  Journal  of  the  American  Medical  Association, 
March  7,  1903. 


. 


Condensed  Biography 

OF 

DR.  JOHN  L.  IRWIN. 


(Reprinted  from  Polk’s  Medical  Register  and  Directory  of  Noith  America, 
8th  edition  and  Detroit  News,  Feb.  22,  1899.) 


1.  Born  on  site  of  residence,  No.  230  Third  Ave.,  Detroit, 
Michigan. 

2.  Graduate  of  Detroit  public  Cass  school  in  1875. 

3.  Graduate  of  Detroit  public  high  school  in  1878. 

4.  Assistant  to  Prof.  A.  B.  Prescott  in  faculty  of  Univer- 
sity of  Michigan,  department  of  chemistry,  Ann  Arbor,  in 
1879  and  1880. 

5.  Graduate  of  the  department  of  science,  literature  and 
arts,  University  of  Michigan,  Ann  Arbor,  degree  of  Ph.  C., 
in  1880. 

6.  Manufacturing  and  consulting  chemist  for  a chemical 
works,  manufacturers  of  medicines  and  chemicals,  at  Cin- 
cinnati, Ohio,  from  1880  to  1886. 

7.  Graduate  of  the  department  of  medicine  and  surgery, 
University  of  Michigan,  Ann  Arbor,  degree  of  M.  D.,  in 
1889. 

8.  Made  hospital  observations  at  New  York  City  and 
Boston,  and  in  Great  Britain,  Ireland  and  Continental 
Europe  in  1889  and  1890. 

9.  Holds  certificates  for  hospital  courses  and  post- 
graduate study  at  the  University  of  Vienna  General  Hos- 
pital, Vienna,  Austria,  in  1890. 

10.  President  of  the  National  Greek  Letter  Medical 
Fraternity  “Nu  Sigma  Nu,”  from  1893  to  1897. 

11.  Detroit  city  physician  to  Poor  Commission  during 
1893  and  1894. 

12.  Instructor  in  general  chemistry,  physics,  and  toxi- 
cology Detroit  College  of  Medicine  from  1894  to  1900. 

13.  Physician  in  charge  of  department  of  diseases  of 
children,  Harper  Hospital  polyclinic,  Detroit,  from  1898 
to  1900. 

14.  Health  Commissioner  of  Detroit  from  February 
1899,  to  March,  1903. 

15.  Member  American  Medical  Association,  Michigan 
State  and  Wayne  County  Medical  Societies,  Detroit 
Alumni  Association  of  University  of  Michigan,  Ohio  State 
Pharmaceutical  Association,  Detroit  High  School  Alumni 
Association  and  Corinthian  Lodge,  No.  241,  F.  & A.  M. 

16.  Contributor  to  medical  and  chemical  literature. 

17.  For  private  reasons  declined  an  invitation  from 
Governor  H.  S.  Pingree  to  act  as  contract  surgeon  to  one 
of  the  Michigan  regiments  during  the  Spanish-American 
war. 


